Abstract
BackgroundThere are no established effective treatments for COVID-19. While novel drugs are being developed, azithromycin has been identified as a candidate treatment in the interim.AimTo review the evidence for the effectiveness and safety of azithromycin in treating COVID-19.Design & settingA rapid review of the literature was conducted.MethodElectronic searches were conducted on 16 April 2020 of PubMed, TRIP, EPPI COVID Living Map, MedRxiv, GoogleScholar, and Google. In vivo and in vitro studies were included assessing the safety and effectiveness of azithromycin for treatment of COVID-19, and/or the activity of azithromycin against SARS-CoV-2. In vivo studies needed to include a comparator group.ResultsThree studies were identified, two in vitro and one in vivo, which were suitable for inclusion. All three were published as pre-prints. The in vitro studies revealed conflicting results, with one finding anti-SARS-CoV-2 activity for azithromycin alone, while the other found activity against SARS-CoV-2 only when azithromycin was combined with hydroxychloroquine. A small trial of 36 patients, with high risk of bias, found superior viral clearance in patients with COVID-19 treated with azithromycin and hydroxychloroquine combined, compared with hydroxychloroquine alone.ConclusionThere is no evidence to support the use of azithromycin for the treatment of COVID-19 outside of the context of clinical trials, unless it is used to treat bacterial super-infection. There is extremely limited evidence of a possible synergy between azithromycin and hydroxychloroquine. The adverse events profile of azithromycin in the context of COVID-19 has not yet been established. Well-conducted clinical trials are urgently needed in this area.
Highlights
COVID-19 was declared a pandemic by the World Health Organization on 11 March 2020.1 Intensive work is being conducted internationally to develop novel treatments for, or a vaccine to prevent, COVID-19
The in vitro studies revealed conflicting results, with one finding anti-SARS-CoV-2 activity for azithromycin alone, while the other found activity against SARS-C oV-2 only when azithromycin was combined with hydroxychloroquine
A small trial of 36 patients, with high risk of bias, found superior viral clearance in patients with COVID-19 treated with azithromycin and hydroxychloroquine combined, compared with hydroxychloroquine alone
Summary
COVID-19 was declared a pandemic by the World Health Organization on 11 March 2020.1 Intensive work is being conducted internationally to develop novel treatments for, or a vaccine to prevent, COVID-19. A macrolide antibiotic predominantly used to treat respiratory, skin, and soft-tissue infections.[2] There is some in vitro evidence that azithromycin may prevent replication of other viruses, such as human influenza virus H1N13 and Zika virus.[4] The possible mechanism of action of azithromycin against SARS-C oV-2 is currently unknown, some theories have been postulated. Poschet and colleagues[5] found in an in vitro study that azithromycin led to an increase in the pH of host cells, which may impede viral entry, replication, and spread. Poschet et al found that azithromycin reduces levels of the enzyme furin in host cells, and may interfere with viral entry. While novel drugs are being developed, azithromycin has been identified as a candidate treatment in the interim
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